PREVENTION OF VERTICAL TRANSMISSION OF HIV: THE FAMILY CENTRED AND COMMUNITY BASED APPROACH IN PERI-URBAN ZAMBIA Presented by Beatrice Chola Executive Director Bwafwano Integrated Services Organization Georgetown Conference Centre, Washington DC, USA

HIV and AIDS continue to be one of the major health concerns impeding Zambia’s development aspirations Currently, 14.3% of Zambia’s adult population aged between are living with HIV (ZDHS-2007) 16.1% of women in the same age group are known to be living with HIV in Zambia (ZDHS-2007) Vertical transmission of HIV accounts among the five key drivers of the transmission of HIV in Zambia

 Established in 1996 due to increasing number of deaths due to HIV and TB in Chazanga  There was no clinic in the catchment area  Bwafwano established a community health clinic as an entry point for health services  Worked with community leaders to identify community volunteers to be trained as home-based caregivers  Linked the home-based care to the community clinic

Built a strong partnership with the community through involvement in the planning, implementation, monitoring and evaluation of programs As a result this has built strong ownership of the programs leading to sustainability of the programs HIV+ mothers with their babies attending a health education session at Bwafwano Community Clinic

-HIV prevention -Treatment -Care and support -Maternal and child health -Social support to meet the needs of mothers and children FOCUS OF BISO PROGRAMS Child born of HIV+ mother being weighed during a Growth Monitoring Clinic Session at Bwafwano Community Clinic by a growth monitor.

 Bwafwano started PMTCT in 2008 The main part of the program are:  Client identification  Clinical services  Community-based support

 The success of the program to prevent vertical transmission of HIV hugely lies on the identification of clients.  HIV+ mothers are identified through community-based strategies, such as:  Community Volunteers who conduct Home-Based Counseling and Testing (HCT)  Inclusion of men in home-based care as providers to improve male involvement  Formation of Male Support Groups  Safe Motherhood Action Groups (SMAGs)

 Clients are also identified through the community clinic in:  Integrated Management of Childhood Illness Clinic  Maternal and Child Health  Outpatient clinic  ART clinic

 Pre-natal Care  Monitoring CD4 count  Treatment Plan  General examination of the patient  Monitoring Pregnancy  Treating opportunistic infections  Referral for obstetric care (when necessary)  Health Talks

 Post-natal Care  Maternal health and family planning services  Physical examination of newborn  Growth monitoring and immunization of the child  Sensitization on importance of PCR  PCR for early infant diagnosis  Pediatric ART  Infant feeding options, e.g. breastfeeding for six months

 Good quality care by monitoring patients through the community laboratory  Laboratory testing includes:  TB diagnosis  Malaria  HB  STI  Full blood count  Hematology analyzer  Chemistry analyzer

Enrolment in the Community Home Based Care Program  Home visitations  Treatment adherence  Addressing stigma and discrimination  Counseling and testing of family members  Disclosure of status  Follow-up of lost patients  Mother Support Groups as peer educators

 Health talks, including  nutrition and cooking demonstration using locally available foods  Hygiene  PCR sensitization  Community outreach  Linkages with other support providers (FBOs, CBOs, government health clinics)

SOCIAL SUPPORT SERVICES Community Facilitator reaching out to women during one on one outreach Income Generation Skills Training for HIV+ mothers Business skills training Savings and loan Skills training, (tailoring, bead- making)

Support and services for children includes:  Early childhood development program  Community school  Integrated into government schools Nutrition Support – school feeding program

 Psychosocial Support  Counseling  Spiritual  Recreation  Shelter provision  Child Protection Services  Skills training for youth

 Increase in women enrolled in PMTCT  1,032 women enrolled in PMTCT  232 on ART  800 have their CD4 count monitored  Low defaulter rate

 Low HIV infection rates among children born of HIV+ mothers  Reduction in child mortality rate  2000 to 2007 – ART only deaths  2008 to 2012 – PMTCT included - 26 deaths  Currently 94 children enrolled in pediatric ART

 Involvement of Community Leaders and Community Volunteers in client identification and follow-up  Family-based approach model which ensures men involvement in PMTCT, maternal, neonatal and child health issues  Women enrolled in PMTCT have access to ART,, family planning services, and ongoing support through home- based care

 Integrated model of service provision (One Stop Shop) allows clients to receive all services from one facility without being referred elsewhere  Partnerships with other support programs, such as with Habitat for Humanity Zambia widens the range of support to overcome social challenges  Specific program of support focused on the needs of the infant and child  Stigma and discrimination addressed early in the support groups and community outreach

CHALLENGES Increasing male Involvement Limited alternative infant feeding options Inadequate financial resources and clinical human resources to provide medical care An HIV+ woman receiving micro-nutrients for her twin children

THANK YOU